Patient Survey

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Patient Satisfaction Survey

At the Midwest Bone & Joint Institute, we are constantly striving to offer our patients the best possible care. Please take a few minutes to fill out the following Patient Satisfaction Survey to let us know how we’re performing. All of your information and answers will be kept strictly confidential. Your name and email address will be used ONLY for the purpose of this survey. We DO NOT share or sell patient’s names or email addresses.

Patient Name

Patient Email

When you called to make your appointment, was the person you spoke with polite and professional? If no, please explain in the box below.

Were you able to get an appointment with the doctor you wished to see? If no, please explain.

What location did you visit?

What time was your appointment?

When you arrived at our offices, did our staff greet you in a friendly manner? If no, please explain in the box below.

How long did you spend in our waiting room?

How long did you spend in an exam room before seeing a doctor?

Which one of our doctors did you see?

How did you hear about the Midwest Bone & Joint Institute?

Would you refer us to a friend or family member? If no, please explain in the box below.

Please list any additional suggestions, comments or feedback in the box below.

If we have questions about your survey answers, would you mind if we contact you?

Email/Telephone
Please enter your 7 digit phone number plus area code.

*Enter Security Code

*Required